A UCLA study of the rate of uninsurance in metropolitan markets found wide variance — from 7 percent in Akron, Ohio, to 35 percent in El Paso, Texas — and that large numbers of immigrants correlate with low rates of health coverage.... The most cost-effective test for colon cancer? Flexible sigmoidoscopy every five years, says the U.S. Agency for Healthcare Research and Quality. Cost per life-year saved was $12,636.... Add HIV and AIDS to the list of conditions requiring standing referrals to specialists in California, thanks to legislation signed by Gov. Gray Davis.... A magistrate ruled that the Massachusetts Board of Registration in Medicine went too far when it suspended the license of a cardiologist who left a profane message on a Blue Cross Blue Shield of Massachusetts answering machine. The physician called employees "criminals" and threatened to beat them "to death," but psychologists who examined him agreed he had no intention of carrying out his threats. The board must decide whether to accept the ruling.
Managed Care’s Top Ten Articles of 2016
There’s a lot more going on in health care than mergers (Aetna-Humana, Anthem-Cigna) creating huge players. Hundreds of insurers operate in 50 different states. Self-insured employers, ACA public exchanges, Medicare Advantage, and Medicaid managed care plans crowd an increasingly complex market.
They bring a different mindset. They’re willing to work in teams and focus on the sort of evidence-based medicine that can guide health care’s transformation into a system based on value. One question: How well will this new generation of data-driven MDs deal with patients?
A flood of tests have insurers ramping up prior authorization and utilization review. Information overload is a problem. As doctors struggle to keep up, health plans need to get ahead of the development of the technology in order to successfully manage genetic testing appropriately.
More companies are self-insuring—and it’s not just large employers that are striking out on their own. The percentage of employers who fully self-insure increased by 44% in 1999 to 63% in 2015. Self-insurance may give employers more control over benefit packages, and stop-loss protects them against uncapped liability.